Healthcare Provider Details

I. General information

NPI: 1124803093
Provider Name (Legal Business Name): MAX CAJAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CARR ST
WATSONVILLE CA
95076-4710
US

IV. Provider business mailing address

10 CARR ST
WATSONVILLE CA
95076-4710
US

V. Phone/Fax

Practice location:
  • Phone: 831-768-8132
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: